Anxiety disorders in an attention-deficit/hyperactivity disorder clinical sample.

[Article in Portuguese]
Souza I, Pinheiro MA, Mattos P.
ADHD Unit, Grupo de Estudos do Deficit de Atencao-GEDA, Institute of Psychiatry, Federal University of Rio de JaneiroRio de Janeiro, RJ, Brazil. isabellagss@terra.com.br

Arq Neuropsiquiatr. 2005 Jun;63(2B):407-9. Epub 2005 Jul 25.

OBJECTIVE: To evaluate the prevalence of anxiety disorders in a clinical referred sample of children and adolescents with attention deficit/hyperactivity disorder (ADHD).

METHOD: 78 children and adolescents with ADHD according to DSM-IV criteria were investigated with a semi-structured interview (P-CHIPS), complemented by clinical interviews with the children or adolescents and their parents. Their IQ was calculated with neuropsychological testing.

RESULTS: A high prevalence of anxiety disorders (23.05%) was found in the sample. Generalized anxiety disorder was the most prevalent disorder (12,8%), followed by social phobia (3,84%) and separation anxiety disorder (3,8%). Two children showed more than one anxiety disorder.

CONCLUSION: Children and adolescents with ADHD seem to be more prone to have comorbid anxiety disorders, at least in clinical samples referred to specialized units.

PMID: 16059589 [PubMed - in process]

Is iron deficiency causative of attention-deficit/hyperactivity disorder?

D'Amato TJ.

Arch Pediatr Adolesc Med. 2005 Aug;159(8):788.

This letter is regarding the article by Konofal et al entitled "Iron Deficiency in Children With Attention-Deficit/Hyperactivity Disorder [ADHD]." 1 Their conclusion that their results suggest that low iron stores contribute to ADHD seems to possibly be incorrect. In their sample populations they do not distinguish between those who had been taking medicines for ADHD and those who had not. It is possible that the low iron stores of children with ADHD who are taking medications are due to the decreased appetite that these medications can cause (and thus decreased oral intake of iron-rich foods). It is also possible that those with ADHD (whether they're taking medications or not) have a decreased ability to sit still for a meal and therefore have decreased nutritional intake of iron. Third, the low iron stores in the children with ADHD could be secondary to the medication that they were taking despite the fact that they were reportedly not taking medicines for 2 months. This possibility cannot be further deduced from their data as presented since, as mentioned earlier, they did not distinguish in their sample populations between those who were medicated and those who were not.

Therefore, I do not feel that the conclusion that low iron stores contribute in a causative way to ADHD can be scientifically drawn from the results presented in this study.
Theresa J. D'Amato, MD

REFERENCES
1. Konofal E, Lecendreux M, Arnulf I, Mourenin MC. Iron deficiency in children with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med. 2004;158:1113-1115.

PMID: 16061790 [PubMed - in process]

Parental recall of pre-school behavior related to ADHD and disruptive behavior disorder.

Ercan ES, Somer O, Amado S, Thompson D.
Ege Universitesi, 35100-Bornova, Izmir, Turkey. eyercan@med.ege.edu.tr
Child Psychiatry Hum Dev. 2005 Summer;35(4):299-313.

The aim of this study was to examine the contribution of Age of Onset Criterion (AOC) to the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and disruptive behavior disorder. For this purpose, a 10-item Likert-type Parent Assessment of Pre-school Behavior Scale (PARPS), developed by the experimenters, was used to examine the presence of ADHD related pre-school behaviors in a sample of 246 children. Factor analysis and correlational analysis imply the continuity of ADHD and disruptive behavior disorder from pre-school to the elementary school years. Discriminant analysis was used to examine the diagnostic capabilities of PARPS, both by itself, and in conjunction with a battery of widely used diagnostic and clinical ADHD and disruptive behavior scales. The results of this study suggest that PARPS is a short and user-friendly scale that can contribute to the examination of the presence of AOC in ADHD and disruptive behavior disorder.

PMID: 15886866 [PubMed - indexed for MEDLINE]

Growth on stimulant medication; clarifying the confusion: a review.
Poulton A.
Western Clinical School, Nepean Campus, The University of Sydney, Australia. sally_poulton@iinet.net.au

Arch Dis Child. 2005 Aug;90(8):801-6.

AIMS: To get an overview of the studies of growth in height in children with attention deficit hyperactivity disorder (ADHD) treated with stimulant medication, to establish the consistencies and to try to resolve the discrepancies.
METHODS: Twenty nine studies were reviewed following a Medline search: 22 related to children, six to late adolescents or adults, and one to children and adults.

RESULTS: Children: Eleven studies gave results consistent with height attenuation on stimulant medication: eight were longitudinal, one was cross-sectional, and two showed growth rebound on ceasing medication. Studies with negative findings were inadequately powered (n = 3), lacked controls or statistical analysis (n = 3), measured height velocity without reference to treatment duration (n = 2), or used inappropriate growth parameters (n = 1), controls (n = 1), or normative data (n = 1). Late adolescents/adults treated with stimulant medication in childhood: Two studies associated childhood gastrointestinal side effects with attenuated late adolescent or adult height; all six cross-sectional studies had negative findings. The methodologies varied widely but there was some consistency in the degree of attenuation shown in studies with positive findings. The most sensitive methods analysed the changes in z-scores (standard deviation scores) or calculated the height deficits from paired measurements taken before and after an initial period of treatment with stimulant medication. The height deficit amounted to approximately 1 cm/year during the first 1-3 years of treatment.
CONCLUSIONS: Further research is needed into the causal mechanisms, the rate of physical maturation, and the long term implications for final stature.

Use of methylphenidate for attention-deficit hyperactivity disorder in patients with epilepsy or electroencephalographic abnormalities.

Gucuyener K, Erdemoglu AK, Senol S, Serdaroglu A, Soysal S, Kockar AI.

Department of Pediatric Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey.

Methylphenidate is commonly believed to lower seizure threshold. The safe use of methylphenidate has not been clarified in patients with attention-deficit hyperactivity disorder (ADHD) and concomitant active seizure or electroencephalographic (EEG) abnormalities. Patients with ADHD and active seizures (n = 57) and patients with ADHD and EEG abnormalities (n = 62), 6 to 16 years of age, were included in the study. The safety and efficacy of treatment with antiepilepsy drugs combined with methylphenidate were determined by assessing seizure frequency, changes in ADHD symptoms, the Conners' Rating Scales, EEG differences, and side effects. The Conners' Rating Scales, performed by parents and teachers, and mean total ADHD symptom scores at the beginning of the study and at the end were significantly different (P = .05 for the Conners' Rating Scales and P = .001 for ADHD symptom scores). Methylphenidate had a beneficial effect on EEG. Seizure frequency did not change from baseline. The side effects of methylphenidate were mild and transient Methylphenidate is safe and effective in children with ADHD and concomitant active seizures or EEG abnormalities.

PMID: 12693777 [PubMed - indexed for MEDLINE]